Medicaid agency: Nevada Health Authority (NVHA) / Nevada Medicaid
Nevada Medicaid is administered by the Nevada Health Authority (NVHA), formed in 2025 when the former Department of Health and Human Services split into two agencies: NVHA, which also houses the Silver State Health Insurance Exchange and the Public Employees' Benefits Program, and the Department of Human Services, home to Aging and Disability Services, Child and Family Services, Public and Behavioral Health, and Social Services. Nevada's mandatory managed care program in Clark and Washoe Counties dates to 1996, run under a Section 1915(b) waiver; a 2025 rebid extended mandatory managed care statewide effective January 1, 2026, moving roughly 75,000 rural residents off fee-for-service. Five MCOs now operate under one shared contract vehicle running through December 31, 2030, though only two of them, SilverSummit and a new fifth entrant, CareSource, actually serve the new rural areas; Health Plan of Nevada remains limited to Clark County, and Anthem (branded Community Care Health Plan of Nevada) and Molina remain limited to Clark and Washoe Counties. Nevada Check Up, the state's CHIP program, delivers the same Medicaid state plan benefits through the same MCO network in urban counties, with the Division of Social Services handling eligibility while NVHA sets benefit policy; Nevada expanded Medicaid under the ACA in January 2014. Nevada's Medicaid Work and Community Engagement requirements, tied to federal law H.R. 1, take effect January 1, 2027 for expansion adults ages 19-64, requiring 80 hours of monthly qualifying activity, with self-attestation accepted in 2027 and documentation required starting 2028; Nevada has joined the multistate litigation challenging the CMS rule that narrowed the medically-frail work-requirement exemption, which remains pending ahead of that deadline.
CMS's most recent managed care enrollment data, report year 2024, predates Nevada's 2026 statewide expansion and reflects the prior structure: four comprehensive MCOs serving only Clark and Washoe Counties (UnitedHealthcare Health Plan of Nevada, branded Health Plan of Nevada; Anthem Blue Cross and Blue Shield Healthcare Solutions; SilverSummit Health Plan; and Molina Healthcare of Nevada), with combined enrollment of 613,298 members. LIBERTY Dental Plan of Nevada served as the separate dental-only Prepaid Ambulatory Health Plan for these same MCO enrollees, covering 618,649 members in the same report year.
Long-term services and supports run separately from Nevada's MCO contracts, through four active Section 1915(c) home- and community-based waivers: the Frail Elderly, Physical Disabilities, and Intellectual and Developmental Disabilities waivers, plus Structured Family Caregiving, created for people with a dementia diagnosis and open for provider enrollment since March 2025. Nevada Medicaid holds each waiver's federal authority, but the Aging and Disability Services Division, now under the Department of Human Services following the 2025 agency split, determines functional eligibility and operates all four day to day.
Not integrated into managed care
Behavioral health is capitated into the five comprehensive MCOs' own contracts alongside physical health, not carved out to a separate health plan. Nevada also operates Certified Community Behavioral Health Clinics under their own Section 1915(b) waiver, serving anyone who needs behavioral health care and primary care screenings regardless of insurance status or MCO enrollment. Nevada Medicaid dropped its plan for a separate, fully risk-based specialty managed care plan for children with complex behavioral health needs and children in foster care, choosing instead to pursue a centralized care-coordination model that does not create a new risk-bearing health plan.
Carved in
LIBERTY Dental Plan of Nevada has administered dental benefits for Nevada Medicaid and Nevada Check Up members enrolled in an MCO, under its own Section 1915(b) waiver, since January 1, 2018; MCO-enrolled members are automatically enrolled with LIBERTY, and only emergency or palliative dental care is handled directly by the MCOs. LIBERTY's own materials do not say whether this arrangement now extends to members newly enrolled in CareSource and SilverSummit's rural service areas following the January 2026 statewide expansion.
Magellan Medicaid Administration, Inc. (part of Prime Therapeutics) has administered Nevada's fee-for-service pharmacy benefit since July 1, 2022. Effective January 1, 2026, every MCO was also required to adopt the same state-published Preferred Drug List used in fee-for-service, standardizing which drugs are covered across Nevada Medicaid regardless of enrollment type.
MTM serves as the non-emergency medical transportation broker for all Medicaid recipients, managed care and fee-for-service alike, in Clark and Washoe Counties. Elsewhere in the state, fee-for-service recipients go directly to SafeRide, while managed care recipients in CareSource or SilverSummit, the two MCOs serving rural service areas, are routed to SafeRide through their own plan.
Gainwell Technologies is Nevada's Medicaid Management Information System fiscal agent, operating the interChange system and the medicaid.nv.gov provider portal.
869 agency updates tracked for Nevada. Available with Pro.
See them with ProThe Nevada Division of Insurance approved an average 17% rate increase for Nevada Health Link marketplace plans for 2027, the second straight year of double-digit hikes after last year's 26% jump. Open enrollment runs Nov. 1 through Jan. 15, 2027, with 12 insurers offering 165 plans, including the state's public-option Battle Born State Plans. About 82% of the marketplace's 100,000-plus enrollees receive federal subsidies, a share that has declined after Congress did not extend enhanced premium tax credits. State officials report rising cancellations due to non-payment, growing numbers of enrollees downgrading to cheaper plans, and expect enrollment to fall further alongside new federal Medicaid work requirements, trends they warn will push up Nevada's uninsured rate.
Rep. Dina Titus (D-NV) and state Sen. Carrie Buck (R-Henderson) are competing for Nevada's 1st Congressional District seat, which covers Downtown Las Vegas, the Strip, Henderson, and Boulder City. Both candidates agree on reinstating Affordable Care Act premium subsidies to prevent coverage loss and premium increases for thousands of Nevadans. The candidates differ on Medicaid work requirements, with implications for program eligibility and enrollment in Nevada's Medicaid expansion population. Both candidates also support deportation enforcement focused on violent criminals rather than all undocumented immigrants, a position relevant to emergency Medicaid utilization patterns.
Nevada Medicaid began mailing notices to affected enrollees in early September regarding work requirement eligibility changes taking effect January 1, 2027. The Nevada Health Authority will follow up with text messages and emails throughout September. The changes stem from President Trump-backed policy. Nevada joins a growing number of states implementing work requirements for certain Medicaid populations, which will affect eligibility determination and ongoing enrollment processes.
Nevada Attorney General Aaron Ford's office declined more than half of Medicaid fraud referrals it received, according to reporting examining his prosecution record as he campaigns for governor. Ford defends his office's prosecution rate as high, stating many referrals lack sufficient evidence to pursue criminal charges. The article examines claims made in political advertisements criticizing Ford's handling of Medicaid fraud enforcement. This review comes as states face increasing scrutiny over program integrity and fraud prevention efforts.
Nevada has reduced out-of-state institutional placements for children with behavioral health needs by more than 50% over four years, following federal findings that the state was overrelying on such placements. The state achieved this through expanded community-based services and in-state treatment capacity. The changes address federal requirements under the Americans with Disabilities Act and Medicaid's integration mandate. This matters for state Medicaid agencies and managed care plans managing behavioral health benefits, as it demonstrates a viable pathway to comply with federal home and community-based services requirements while reducing high-cost institutional care.
15 active waivers tracked for Nevada. Available with Pro.
See them with Pro3 active solicitations tracked for Nevada. Available with Pro.
See them with Pro10 managed care contracts tracked for Nevada. Available with Pro.
See them with Pro57 bills tracked for Nevada. Available with Pro.
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